Pcom recurrence treated with multi-vessel reconstruction and coils

51M past-history of WFNS 1 SAH secondary to left foetal Pcom aneurysm rupture treated acutely by second operator with good initial result.

Significant early recurrence on follow-up DSA. For retreatment at ~12 months post-SAH.

Recurrent aneurysm (6.5 x 4.5 mm) involving fetal Pcom and left ICA. Vascular remodeling with Neuroform-Atlas reconstructing Pcom-aneurysm roof and PED-Shield reconstructing ICA-aneurysm wall. Proximal tines of Atlas abutting PED-Shield in T-stent format.

Headway 27 to M1 and PED-Shield positioned in catheter. Headway 17 to Pcom and Atlas deployed with proximal tines positioned at anticipated ICA wall reconstruction. Headway 17 then positioned in aneurysm recurrence and jailed by deploying PED-Shield 3.75 x 10 mm in ICA in contact with proximal Atlas tines. Aneurysm recurrence coiled (Raymond-Roy 1).

Aneurysm remains occluded at 6-month follow-up with no stent complications.

Figure 1 : final DSA from initial acute treatment by second operator demonstrating good result.

Figure 2 : Conventional DSA demonstrating significant early recurrence.

Figure 3 : 3D rotational DSA demonstrating recurrence involving both the true foetal Pcom and ICA.

Figure 4a & b : Atlas in foetal Pcom and PED-Shield in ICA. Aneurysm coiled via jailed Headway 17.

Figure 5 : aneurysm coiled to exclusion.

Figure 6a & b : routine six-month follow-up DSA demonstrating stable, occluded aneurysm without complication.